Getting Off Omeprazole-Prilosec and other PPIs

Getting Off Omeprazole-Prilosec and other PPIs

by Jeffrey Dach MD

Getting off omeprazole and other PPI’s (proton pump inhibitors) can be difficult because of the nasty rebound hyper-acidity caused by high gastrin levels.

In a 2006 study by Björnsson, 97 patients had been on PPI drugs for for 48 months.  Three Quarters (78%) were taking PPIs for GERD. The 97 patients were divided into two groups.  Group One, the NON-Taper group took omeprazole 20 mg daily for 3 weeks, then stopped.  Group Two, the Taper group took 20 mg daily for 1 week, then 10-mg daily for 1 week and then 10-mg every other day for 1 week, then stopped.

Without the omeprazole tapering, patients were only 22% successful at stopping.  With tapering, this improved to 31% of people who were successful in stopping their omeprazole. Although the tapering schedule increased the success of stopping, from 22 to 31 per cent, this was still only a dismal 31% success rate.  How do we increase the odds of success?(61)

How to Increase Odds of Success with More Gradual Taper

We would like to have an 80-90% success rate by using a more gradual taper schedule to increase the odds of success. Thankfully, this is easy to do as the omeprazole capsule contains about 150 small slow release granules.  See upper left photo of the granules emptied out of an omeprazole capsule.  One can easily open the capsule and count out the exact number of granules to remove each day for the tapering schedule.

Pulling the Capsule Apart

The two ends of the capsule simple pull apart with a slight twisting motion.  One can then pour out the granules into a small bowel or cup.  If you use a dark background, the light colored granules can be more easily counted. Using a blunt butter knife, remove a number of granules each day as provided by your tapering schedule.  For example, for a 40 mg capsule, remove 10 granules every two or three days for a gradual taper.  Take the granules by mixing with apple sauce. (1-2)  Left image 40 mg omeprazole capsule courtesy of CVS.

If you experience symptoms of rebound hyperacidity, hopefully they will be mild and easy to tolerate with antacids such as Mylanta, Gaviscon or Tums, or some of the other natural remedies and diet changes listed below. Another suggestion  to deal with rebound hyperacidity symptoms is to prolong or maintain the taper at the same level for a few days longer so that rebound symptoms resolve before further tapering.

PPI drugs are very strong inhibitors of stomach acid production. The drug’s largest effect is at 24 hours after a dose, and the effect reduces stomach acid secretion for up to 72 hours after the dose.  Since the drug effect of Omeprazole can last 72 hours (three days), tapering every three days or more is suggested.  The elevated gastrin levels with rebound hyperacidity can last for a week or two after stopping the drug. (4)

Mylanta, Tums, Gaviscon etc

These are widely available antacids which come as a liquid or chewable tablet.  They contain alkaline substances that neutralize excess stomach acid.  Another widely available agent to neutralize stomach acid is Baking Soda (Sodium Bicarbonate).

DGL, Gum Mastic, Slippery Elm

Slippery Elm Bark Powder can be mixed with boiling water to make a slurry or tea end product.  Once taken, this leaves a protective coating on the walls of the stomach and esophagus which can be a relief.  DGL and Gum Mastic are also very popular for this same purpose.

Apple Cider Vinegar (ACV) and Betaine HCL

When first starting a omeprazole (Prilosc) or other PPI drugs, there is virtually zero acid production by the stomach.  The acid is needed for proper digestion and assimilation of your meal.  Therefore it is suggested that one take apple cider vinegar before each meal.  The usual suggestion is a table spoon in a glass of water.  Use an organic product “with mother” such as Braggs.  Over time the apple cider vinegar (ACV) may erode the teeth, so be careful about this.  The apple cider vinegar increased the acidity in the stomach which is needed for digestion.  This also closes the LES, lower esophageal sphincter, explaining why patients report relief from GERD (gastro-espophageal reflux) with apple cider vinegar.

Again, because of low or absent stomach acid, Gastro-Esophageal Reflux commonly occurs with PPI drug use.  This was discussed in a previous newsletter, part one of this series.  From a purely mechanical point of view, elevating the head of the bed on blocks can help.  Avoid lying down within 2-3 hours of the evening meal can help.  By this time, the stomach has emptied of gastric contents which reduces chance for reflux.  Also, it helps to sleep on the left side.  Avoid rolling over on to your right side, as this will cause GERD and you will notice reflux symptoms in a few minutes.  While in bed, stay on the left side to avoid reflux.

Digestive Enzymes with Betaine

Another useful supplement taken with meals is digestive enzymes with Betaine HCL.  These are digestive enzymes with stomach acid added.  The idea is similar to the apple cider vinegar.  One may take a digestive enzyme plus Betaine to  assist in digestion of the meal, especially for the patient on a PPI drug who has no stomach acid of their own.  This provides the missing stomach acid.

One may notice the stools become pale in color soon after starting a PPI drug because of lack of gastric acid.  Once Acid Cider Vinegar or The Digestive Enzymes/ Betaine is added with each meal, the stools return to normal color.

However, one must be careful to wait until the acute phase of the illness has resolved before starting the digestive enzymes and Betaine HCL.  For example, if the  PPI drug is taken for symptoms of Gastritis, one must  wait a few weeks after starting the PPI drug to allow the underlying inflammatory condition to heal before starting supplemental acid at meal times.  Once one starts tapering off the PPI drug, that is a good time to add in the Apple Cider Vinegar or Betaine HCL (or both) with meals.

Another suggested benefit of the ACV or the Betaine acid capsule with meals is the gastrin suppressive effect. With the addition of the acid supplement with meals, the stomach now senses there is already enough acid in the stomach, and no need for simulating gastrin secretion.  This prevents the secretion of high levels of gastrin, which allows for eventual tapering off the PPI drug without severe rebound acidity symptoms.

Switch from a PPI to a H2 blocker drug such as Tagamet (Cimetidine)

Many gastroenterologists will recommend switching from a PPI drug like omeprazole to a H2 blocker such as Tagamet (Cimetidine) which is a weaker agent and can assist in tapering off the PPI.

Aloe Vera

Another useful item is Aloe Vera which grows wild in Florida.  We have a number of large Aloe Plants growing in pots around the house.  The fronds can be harvested and the inner gel removed with a filet technique.  I usually add in the gel from one large frond into a morning smoothie made with coconut water, tumeric and protein powder. For those who do not have access to fresh growing Aloe, there are Aloe products available online such as Aloe Cure on Amazon. Aloe has strong anti-inflammatory properties.

Taking a PPI for GERD

In most cases, taking a PPI drug for GERD is probably not a good idea, and we have seen a shift in the recent medical literature which no longer recommends long term PPI use for GERD.  This is called “deprescribing PPI drugs” . (54-55)

Part of the reasoning behind this is the GERD (gastro esophageal reflux) is usually caused not by excess acid, but rather by a deficiency in stomach acid which is needed to trigger closure of the lower esophageal sphincter.  The commonly reported relief with Apple Cider Vinegar is supportive of this idea.

Although acid levels are reduced, the refluxed contents of the stomach are still very irritating to the lower esophagus and causes characteristic “heartburn” discomfort and pain.  PPI drugs will give relief, but getting off the PPI drug makes the heartburn worse, which makes getting off impossible, thus creating a large population of chronic long term PPI users.

Conclusion:  A gradual taper by counting and removing granules helps to avoid severe acid rebound symptoms, and increases chances of successfully tapering off the PPI drug.  Antacids, and other natural remedies have a role to play and can be very helpful in dealing with the mild rebound hyperacidity symptoms and the PPI associated GERD (acid reflux) during tapering.

Articles with Related Interest

Heartburn GERD and PPI Stomach Acid Blocking Drugs

The Lady in Grey –  Hair Loss From Low Stomach Acid

Jeffrey Dach MD

Links and References

Header Image : Omeprazole Beads photo courtesy of Jeffrey Dach MD

Image of Omeprazole capsule courtesy of CVS

Getting Off Omeprazole and Prilosec

OPen the Capsule

1) Clin Gastroenterol Hepatol  2017 Apr;15(4):494-500.e1.
Opened Proton Pump Inhibitor Capsules Reduce Time to Healing Compared With Intact Capsules for Marginal Ulceration Following Roux-en-Y Gastric Bypass
Allison R Schulman 1 , Walter W Chan 1 , Aiofe Devery 2 , Michele B Ryan 2 , Christopher C Thompson 3

2) Cleveland Clinic Opent the Omeprazole capsules (sprinkle caps) – Rx

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Do not cut, crush or chew this medicine. Swallow the capsules whole.You may open the capsule and put the contents in 1 tablespoon of applesauce.Swallow the medicine and applesauce right away. Do not chew the medicine or applesauce. Take this medicine before a meal. Take your medicine at regular intervals.

3) How To Quit Prilosec and Zantac

This blog was made to help other people who might want to quit or cut down on their Prilosec, Zantac and other PPI drugs prescribed for acid reflux. It can be difficult to handle the rebound side effects of quitting cold turkey.  December 8, 2010
Buy antacids such as Tums or Mylanta (Aluminum hydroxide/ Magnesium Hydroxide).


4) Omeprazole Half-Life – How Long Does it Stay in Your System?  May 19, 2020 Manuela Callari, PhD Medically reviewed by Paul Bossung

Omeprazole has an oral bioavailability of about 30 to 40% at doses of 20 to 40 mg. Plasma concentration peaks within 0.5 hours, and the drug is rapidly absorbed, generally within 0.5 to 3.5 hours. It clears from the plasma within 4 hours, and it is completely metabolized by the liver. Metabolites are excreted mostly in the urine, and the rest via bile. Even though the half life is relatively short there is the largest effect at 24 hours, and can assist with reducing stomach acid secretion for up to 72 hours.

Does omeprazole last 24 hours?
After oral administration, the onset of the antisecretory effect of omeprazole occurs within one hour, and the inhibition of stomach acid secretion can last up to 72 hours.

slippery elm bark/ apple cider vinegar

5)  How to Wean Off Acid Blockers  Gut Health

First, removing the obvious triggers. That differs for everyone but the more common ones are spicy foods, tomatoes, citrus, caffeine, chocolate and alcohol.
heavily processed foods, bad fats like processed vegetable oils, high sugar foods, poor quality dairy and most grain-based foods.

I HIGHLY recommend going gluten free and if possible, fully grain-free for an entire month.

Whatever your current dose, cut it down by a 1/4 of a pill. Get a pill cutter so you can do this easily. So if you’re taking a 20 mg pill, cut off about a quarter so that you’re now taking about 15 mg. If you’re taking a 20 mg pill twice a day, do this only with the morning or evening dose and keep the other dose at 20 mg.

Do this for a minimum of two weeks.

Try taking a little apple cider vinegar at the beginning of each meal (1-2 TBSPs in 2-4 ounces of water). This will help promote gastric enzyme activity. Apple cider vinegar is renowned for its ability to boost your stomach’s digestive capacity

I like slippery elm bark tea as it’s very easy to take and very soothing to the stomach. Slippery elm bark is mucilaginous and helps to coat and soothe the stomach lining. It can also help with acid reflux as well. (source).

To make a tea, get some slippery elm bark in powder form and take 1-2 teaspoons, mix with a little cold water into a smooth paste, then pour boiling water over it and continue to whisk and stir for a few minutes until it forms a slippery consistency. You can add a squeeze of lemon or even better, some fresh chopped ginger (which also has gut healing properties) to improve the taste a little. Drink a few cups throughout the day as well as well as in the evening before bed.

Marshmallow root tea works in a similar fashion to slippery elm bark.

Other gut healing supplements that can help include deglycyrrhizinated licorice (DGL), aloe vera juice, probiotics and L-glutamine.

As far as anti-inflammatory foods go, bone broths and fermented foods are at the top of the list!

if possible, try taking 1 teaspoon of baking soda in half a cup of water. This is a natural antacid approach and preferable to conventional antacids. Some apple cider vinegar dissolved in water may also work.

If it doesn’t work, it’s OK to use something like TUMS or Rolaids if it gets you out of discomfort. You might also consider using an H2 acid blocker like Zantac, Tagamet or Pepcid as they are not as harsh on your stomach as PPIs.

Use antacids or H2 acid blockers as needed to temporarily relieve discomfort. Ideally, you don’t want to use these too often though.

“crazy tea”: 1 tsp ginger powder, 1tsp lemon juice, 1 to 2 tblspoon raw apple cider vinegar, 1 tablespoon raw honey and tea to taste ( about a cup hot or cold). I also take an enzyme at start of meal.

6) Coming Off a Proton Pump Inhibitor
“Coming Off a Proton Pump Inhibitor” was written by David Rakel, MD and updated by David Lessens, MD, MPH and Sagar Shah, MD. (2014, updated 2020). Sections were adapted from “Gastroesophageal Reflux Disease” by David Kiefer, MD, David Rakel, MD, and Rian Podein, MD.


For patients who have made positive lifestyle changes and are less likely to need continued chronic acid suppression, it can still be difficult to come off PPIs. They often cause rebound hyperacidity, even if the underlying condition has resolved.[1] This occurs due to the lower stomach acidity increasing gastrin secretion, which causes the enterochromaffin cells to hypertrophy. When the PPI is suddenly discontinued, these larger cells have an increased capacity for acid secretion.[2] Figure 1 shows symptoms scores for dyspepsia in asymptomatic people given 40 milligrams of pantoprazole for 6 weeks versus controls. Despite being initially asymptomatic, they experienced rebound dyspepsia that lasted 10-14 days.[1]

7) Helping Taper off a Proton Pump Inhibitor

Handout created by David Rakel, MD, Assoc. Prof. & Director of the Integrative Medicine Program, Dept. of Family Medicine, University of Wisconsin-Madison. Adapted from a chapter on Gastroesophageal Reflux Disease. In: Rakel DP (Ed.) Integrative Medicine, 3rd Ed. Philadelphia, PA: WB Saunders; In print.

Add one or more of the following:

Deglycyrrhizinated Licorice (DGL), 2-4 380 mg tablets before meals or Sucralfate (Carafate) 1 gm before meals.

Slippery Elm, 1-2 tbsp of powdered root in water or 400-500 mg capsules or 5 ml of a tincture TID to QID
A combination botanical product, Iberogast® (Clown’s mustard, German chamomile, angelica root, caraway, milk thistle, lemon balm, celandine, licorice root and peppermint leaf). 1 ml TID3 (Can get here: Iberogast on Amazon)*

8) David Kiefer, MD and David Rakel, MD from the Integrative Medicine Program at the University of Wisconsin Department of Family Medicine discuss gastroesophageal reflux disease and a number of strategies to help patients come off of a proton pump inhibitor.

9) Getting off proton pump inhibitors  If patients want off of the drug I urge them to talk to their MD, and wean off slowly. The doctor will hopefully have them switch to an H2 agonist which is less overwhelming to the system and must be taken twice per day. Then have them switch to a simple charcoal or calcium based antacid, and then to nothing.

10) Stopping your Proton Pump Inhibitor or “PPI”

11) Health/Fitness April 28, 2010  How I Got Off Nexium. For Good.

12) Steps To Take & What To Expect When Weaning From A PPI

13)  The Best Natural Alternatives to Omeprazole By Max. D Gray. Updated: May 16, 2017

How To Quit Prilosec and Zantac

This blog was made to help other people who might want to quit or cut down on their Prilosec, Zantac and other PPI drugs prescribed for acid reflux. It can be difficult to handle the rebound side effects of quitting cold turkey.  Wednesday, December 8, 2010

15) How to quit Prilosec, (Omeprazole) and Zantac (Ranitidine)

The conventional medical community got stomach acid wrong – I’d get off of that Prilosec if I were you

slippery elm, marshmallow root and licorice root.

16) How I healed my gastritis  Last year I was diagnosed with h.pylori negative moderate gastritis with erosions in the lower part of my stomach after having a gastroscopy. I’d been experiencing severed burning pain in my stomach and heartburn / reflux for about 2 months before the scope and had already cut out acidic foods, red meat, and gluten, as I found they all made it worse. I was already caffeine, alcohol, and dairy free. I’d been taking 40mg PPIs plus gaviscon when I needed it for about 10 weeks. I’d lost a lot of weight and had zero apetite. It was miserable.

After the scope, I went back to the gastro dr and he said that even though my gastritis was inactive, I should remain on the PPIs. When I asked how long for, he said it was fine to take them forever if I wanted to. That didn’t sit right with me. I already take medication daily for a heart condition and didn’t want to add another longterm medication without looking at why I’d developed gastritis in the first place.

So after some research, I saw a nutritionist / naturopath, and she helped me come up with a plan. For three months I stayed on this diet and supplement plan:

Cut out red meat, caffeine (even tea), chocolate, fried food, no alcohol, dairy, gluten, citrus, tomato, fatty foods.

Ate instead:

Fish and lean chicken, grilled or air fried, well cooked green vegetables (raw hurt my stomach), sweet potato, pumpkin, oats, chia puddings, bananas, apples, papaya (as often as possible as I found it really soothing) rice, quinoa, chamomile tea, ginger tea, rooibos tea.


Bioceuticals Pepzin Z Pro

Gut Health powder


GINGER. Ginger was like water on a flame. I’ve tried super strength Gin Gins and even now I still eat a piece of natural non crystalised ginger after every meal.

The diet was really boring for a while. It wasn’t fun missing out on take out or sitting there with my plain piece of fish and greens every meal while everyone else ate a nice meal. But it was worth it. It’s been four months since starting the supplements, and I can eat red meat, spelt bread (wheat doesn’t cause pain but feel uncomfortable and heavy) I have caffienated tea, chocolate, I’ve tried some fried food with no issues, and had some Mexican food a couple of times. I introduced food very slowly. I still take pepzin but have moved to Doctor’s Best Pepzin GI. I still eat ginger all day. I don’t have any stomach pain or reflux and have a good appetite. I’ve regained the weight I lost and feel great.

I know that everyone is different and if you have h.pylori or are post-antibiotics it’s a whole different thing, but I thought I’d share what worked for me in case it helps someone. I felt like my stomach was going to be ruined forever and I’d never eat happily again but I reckon I’m about 90% improved.

17) Rice, Coconut Milk and Aloe Vera for Gastritis
By Jill Corleone, RDN, LD


Apple cider vinegar

18)  Vinegar and Acid Reflux
“Apple cider vinegar is a great NATURAL remedy for acid reflux!”

19) Natural Remedy: Apple Cider Vinegar for GERD, How I stopped taking Proton Pump Inhibitors (PPI)

June 9, 2011 By Shelley Zurek  …I take Apple Cider Vinegar each morning for my GERD instead of Proton Pump Inhibitors.

20) 6 Natural Omeprazole Alternatives

21) The Best Natural Alternatives to Omeprazole
By Max. D Gray. Updated: May 16, 2017

Omeprazole (or prilosec) for heartburn
Apple cider vinegar
Sodium Bicarbonate
Aloe vera
Lemon juice
Foods high in glutamine
Licorice root
Other useful tips

Apple cider vinegar

The first natural alternative to Omeprazole we can recommend is apple cider vinegar. We recommended you purchase an organic version so to avoid chemical components or additives. Then it will function properly as an inhibitor of heartburn. It is a remedy that works immediately to relieve heartburn and can be served directly by mixing 1 tablespoon of apple cider vinegar with a little water.

22)  Getting Off Omeprazole Peoples Pharmacy
Many remedies can help with the challenge of getting off omeprazole by easing the symptoms of rebound reflux.

23) How to Wean Off PPIs and Why
Heartburn Medication / Monday, July 13th, 2015

I Feel Terrible Coming Off Omeprazole, But Not Anymore


25)  Getting Off PPIs and Acid Rebound – What I Learnt 1st Hand
Last Updated: September 3, 2021

So How Do I Start Tapering? – Start off by skipping a dose of PPIs every third day for 2 weeks which will begin a slow taper. After this 2-week period you can then take a dose every other day for a further 2 weeks. Finally, after that 2-week period you can take a dose every 3rd day. Again, after another 2-week period and you have no more acid rebound symptoms you can discontinue the PPIs completely.

During the transition period alginate medication such as Gaviscon advance (uk version) or a suitable alternative like reflux gourmet or esophageal guardian can be used basically as a bridging agent to make the process smoother. For example, with the Gaviscon taking 2 teaspoons after meals and at bedtime. Also, instead of these alginate medications an h2 blocker (like ranitidine, cimetidine, famotidine etc.) can be used as a bridging agent to help the process of transitioning off the PPIs.

26) How to Use Herbals to Transition Off PPIs?

These include slippery elm root bark and marshmallow root, which come in powdered form that can be mixed with water. “They make kind of a slurry which goes down and coats whatever it touches — the back of your throat, your esophagus, your stomach,” says Kiefer.

Rakel says it’s important for patients to taper off PPIs slowly, first cutting the dose, if possible, and then taking it every other day. He usually recommends patients stay with one herbal remedy while weaning off PPIs.

Kiefer, on the other hand, says patients can combine herbs. He suggests using anti-inflammatories such as chamomile or DGL plus melatonin during the medication tapering process. Once the PPI is gone, herbs that act to coat the GI tract (such as aloe vera or marshmallow root) can be added, he says.

27) Natural Remedies for GERD and ACID

Manuka Honey
Braggs Apple Cider Vinegar
Digestive Enzymes
Throat Coat
Chewing Gum
Baking Soda
Aloe Vera

28) 5 Things You May Not Know About Omeprazole
Sharon Orrange, MD, MPH March 22, 2019


29) How I Managed to Get Off of All Antacids for Good!  TraumaToTarot  August 9, 2021

The next step is to start weening yourself off the antacids. I did tell my doctor that I was going to be doing this. I started with the PPI first since that one is supposed to be the hardest. I cut it down from twice a day to once a day. I did that for two weeks and then went to every other day for two weeks. Then ever two days for two weeks. Then I stopped taking it completely. I actually didn’t find getting off the PPI to be that difficult. I waited another two weeks and then cut my H2 blocker down to once a day. Around this time I ran out of Tums and decided to stop buying them.

30) Getting off PPIs Getting Through Acid Rebound I take liquid flora, calcium-magnesium, Slippery elm tea (when I need it), and a tablet that has slippery elm-marshmellow root-licorice root, and ocassionaly I drink organic apple juice with organic aloe vera juice. I’ve also been eating raw (veggies and fruits), eating healthier, avoiding fried foods, I’ve been juicing, etc.

So what’s working? Same thing every day. All organic.
– celery (before meals and between meals)
corn tortilla with avocado and sliced up spinach 3x a day for my meals. I just started adding up finely diced chicken to it but won’t do it for each meal, just once a day
boiled potatoes w/o skin and boiled carrots. No seasonings
DGL when needed
Zantac 150 morning, usually 75 at night unless i feel it kicking up and then its 150
carafate only as needed
probiotic chewables


CBD for Gastritis

31) Using CBD for Gastritis May Provide the Relief You’re Looking For

32) Does CBD Oil Work For Gastritis? 4 Clinical Studies Say Yes!   July 10, 2020

Your doctor may also recommend medication known as proton pump inhibitors. They work by blocking cells that create stomach acid. However, long term use especially at high doses can lead to an increased risk of spine, hip, and wrist fractures. They can also lead to an increased risk of renal failure, dementia, and nutrient deficiencies. Complications with existing medication has led people to seek alternative solutions outside the medical system. One of those solutions is cannabis-based treatment.

34) Volz MS, Siegmund B, Häuser W. Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden in der Gastroenterologie : Eine systematische Übersichtsarbeit [Efficacy, tolerability, and safety of cannabinoids in gastroenterology: A systematic review]. Schmerz. 2016 Feb;30(1):37-46. German. doi: 10.1007/s00482-015-0087-0. PMID: 26809974.

35) Storr M, Devlin S, Kaplan GG, Panaccione R, Andrews CN. Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease. Inflamm Bowel Dis. 2014 Mar;20(3):472-80. doi: 10.1097/01.MIB.0000440982.79036.d6. PMID: 24407485.

36) Abdel-Salam, Omar ME, et al. “Effect of Cannabis sativa extract on gastric acid secretion, oxidative stress and gastric mucosal integrity in rats.” Comparative Clinical Pathology 24.6 (2015): 1417-1434.

37) Adejumo, Adeyinka MD, MS1; Akanbi, Olalekan MD, MPH2; Bukong, Terence PhD3 Concomitant Cannabis Use Decreases the Risk of Alcoholic Gastritis Among Alcohol Abusers, American Journal of Gastroenterology: October 2018 – Volume 113 – Issue – p S1595 doi: 10.1038/ajg.2018.333

38)  Adejumo, Adeyinka Charles, et al. “Reduced prevalence of alcoholic gastritis in hospitalized individuals who consume cannabis.” Alcoholism: Clinical and Experimental Research 43.2 (2019): 270-276.

39) Adeyinka Adejumo, M. D., and M. D. Olalekan Akanbi. “Concomitant Cannabis Use Decreases the Risk of Alcoholic Gastritis Among Alcohol Abusers.” The American Journal of Gastroenterology 113 (2018): S1595-S1595.

40) Abdel-Salam, Omar. “Gastric acid inhibitory and gastric protective effects of cannabis and cannabinoids.” Asian Pacific journal of tropical medicine 9.5 (2016): 413-419.

41) Castillo, Germán Gabriel, et al. “Study of the gastric acid anti-secretory activity of Cannabis sativa in an animal model.” Colombia Médica 37.4 (2006): 254-257.

42) Abdel-Salam, Omar ME, Amany A. Sleem, and Fatma A. Morsy. “Effect of Cannabis sativa on the indomethacin-induced gastric mucosal damage.” Journal of Basic Pharmacology and Toxicology 3.2 (2019): 26-33.

Indomethacin resulted in multiple mucosal erosions, necrosis, leukocytic infiltration and vascular congestion. These changes were prevented by Cannabis treatment. In conclusion, the systemic administration of Cannabis exerted protective effect against the indomethacin-induced gastric damage which involved inhibition of gastric acid and oxidative stress. This suggests the involvement of cannabinoid receptors in gastric mucosal protection.

43) Borrelli, Francesca. “Cannabinoid CB1 receptor and gastric acid secretion.” Digestive diseases and sciences 52.11 (2007): 3102.

44) Cannabis for Gastritis  Unlike THC, CBD doesn’t bind to CB1 receptors of the ECS. Put simply, this means it doesn’t produce the same euphoric high. In fact, CBD has a low affinity for the major receptors that make up the ECS. Instead, it manages to inhibit enzymes that break down anandamide, one of the main endocannabinoids in the body.

45) Gastritis & CBD

—————————————— —

46) Reimer, Christina, et al. “Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy.Gastroenterology 137.1 (2009): 80-87.

Background & aims: Rebound acid hypersecretion (RAHS) has been demonstrated after 8 weeks of treatment with a proton-pump inhibitor (PPI). If RAHS induces acid-related symptoms, this might lead to PPI dependency and thus have important implications.

Methods: A randomized, double-blind, placebo-controlled trial with 120 healthy volunteers was conducted. Participants were randomized to 12 weeks of placebo or 8 weeks of esomeprazole 40 mg/d followed by 4 weeks with placebo. The Gastrointestinal Symptom Rating Scale (GSRS) was filled out weekly. A score of >2 on 1 of the questions regarding heartburn, acid regurgitation, or dyspepsia was defined as a clinically relevant acid-related symptom.

Results: There were no significant differences between groups in GSRS scores at baseline. GSRS scores for acid-related symptoms were significantly higher in the PPI group at week 10 (1.4 +/- 1.4 vs 1.2 +/- 0.9; P = .023), week 11 (1.4 +/- 1.4 vs 1.2 +/- 0.9; P = .009), and week 12 (1.3 +/- 1.2 vs 1.0 +/- 0.3; P = .001). Forty-four percent (26/59) of those randomized to PPI reported > or = 1 relevant, acid-related symptom in weeks 9-12 compared with 15% (9/59; P < .001) in the placebo group. The proportion reporting dyspepsia, heartburn, or acid regurgitation in the PPI group was 13 of 59 (22%) at week 10, 13 of 59 (22%) at week 11, and 12 of 58 (21%) at week 12. Corresponding figures in the placebo group were 7% at week 10 (P = .034), 5% at week 11 (P = .013), and 2% at week 12 (P = .001).

Conclusions: PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal. This study indicates unrecognized aspects of PPI withdrawal and supports the hypothesis that RAHS has clinical implications.

47) Niklasson, Anna, et al. “Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial.” Official journal of the American College of Gastroenterology| ACG 105.7 (2010): 1531-1537.

Objectives: Conflicting data exist on whether discontinuation of proton pump inhibitors (PPIs) is associated with rebound secretion of gastric acid.

Methods: A total of 48 healthy Helicobacter pylori-negative volunteers (24 females) were randomized in a double-blinded manner to treatment with either pantoprazole 40 mg or placebo once daily for 28 days. Dyspeptic symptoms were registered daily using the Glasgow dyspepsia score (GDS) 2 weeks before, during, and 6 weeks after treatment. Plasma levels of gastrin and serum levels of chromogranin-A levels were measured before, during, and after treatment.

Results: During the 2 weeks before treatment, the placebo group had a mean GDS of 0.20 + or – 0.7 compared with the pantoprazole group score of 0.54 + or – 1.3 (NS). No significant differences between the symptom severity scores of the two groups were shown during the treatment period. During the first week after discontinuation of treatment, the pantoprazole group had a mean symptom score of 5.7 + or – 11.7 vs. 0.74 + or – 2.6 in the placebo group (P<0.01). A total of 11 out of 25 (44%) subjects in the pantoprazole group developed dyspepsia compared with 2 out of 23 (9%) in the placebo group (P<0.01). During the second week of follow-up, the pantoprazole group had a mean symptom score of 1.6 + or – 3.4 compared with 0 + or – 0 in the placebo group (P<0.05). There were no significant differences in the mean symptom score for the pantoprazole group (1.1 + or – 0.6) compared with the placebo group (0.4 + or – 0.3) during the third week of follow-up. Symptom scores during the first week after treatment correlated with basal (P<0.01) and meal-stimulated (P<0.01) gastrin levels at the end of treatment.

Conclusions: A 4-week course of pantoprazole seems to induce dyspeptic symptoms in previously asymptomatic healthy H. pylori-negative subjects. The correlation between symptom score and gastrin levels suggests that these symptoms are due to acid rebound hypersecretion and seem to be related to the degree of acid inhibition.

48) Niklasson, Anna, et al. “Dyspeptic Symptom Development After Discontinuation of a Proton Pump Inhibitor: A Double-Blind Placebo-Controlled Trial.The American Journal of Gastroenterology 105.7 (2010): 1531.

Objective: Rebound acid hypersecretion after withdrawal of proton pump inhibitor (PPI) may lead to symptom aggravation and difficulties in withdrawing anti-reflux medication. The aim was to investigate pathophysiological and clinical consequences of on-demand treatment with PPI in patients with endoscopy-negative reflux disease.

Material and methods: Twenty-six patients with endoscopy-negative reflux disease were investigated for rebound effects of lansoprazole 15 mg, used on-demand, maximum 4 capsules daily during a 6-month period. P-CgA and s-gastrin were measured before, at termination and 2 weeks after stopping treatment. Symptom score was performed the week before and the second week after treatment, 24-h pH-metry after both periods.

Results: Median daily consumption of lansoprazole was 15.1 mg (95% CI: 10.5; 18.8). S-gastrin before treatment was 31.2 pmol/l, 54.8 at the end (p < 0.01), 31.7 two weeks after withdrawal. P-CgA was 16.7 u/l before treatment, 37.5 at the end (p < 0.01), 17.7 two weeks after withdrawal (p = 0.35). A positive correlation was found between total consumption of lansoprazole and CgA increase during treatment (r = 0.44 p = 0.03). There was a reduction in symptom score during the treatment period from 30 (24-38) before, to 20 (15-36) the second week after treatment, p = 0.06. 32% had increase in symptoms.

Conclusions: Rebound acid hypersecretion is probably an infrequent problem in on-demand treatment with PPI in patients with endoscopy-negative reflux disease. A significant increase in p-CgA and s-gastrin was found after 6 months treatment. Fourteen days after withdrawal, CgA and gastrin returned to pretreatment levels. Overall, no aggravation of symptoms was found, but 1/3 experienced increased symptoms.

49) The Overuse of Proton Pump Inhibitors: Implications for Prescribing Physicians
October 15, 2019


50) McColl, Kenneth EL, and Derek Gillen. “Evidence that proton-pump inhibitor therapy induces the symptoms it is used to treat.” Gastroenterology 137.1 (2009): 20-22.

51) Waldum, H. L., et al. “Marked increase in gastric acid secretory capacity after omeprazole treatment.” Gut 39.5 (1996): 649-653.

52) Fossmark, R., et al. “Rebound acid hypersecretion after long‐term inhibition of gastric acid secretion.” Alimentary pharmacology & therapeutics 21.2 (2005): 149-154.

53) Haastrup, Peter, et al. “Strategies for discontinuation of proton pump inhibitors: a systematic review.” Family practice 31.6 (2014): 625-630.

54)  Naunton, M., et al. “We have had a gutful: the need for deprescribing proton pump inhibitors.” Journal of Clinical Pharmacy and Therapeutics 43.1 (2018): 65-72.

55) Helgadottir, Holmfridur, and Einar S. Bjornsson. “Problems associated with deprescribing of proton pump inhibitors.” International journal of molecular sciences 20.21 (2019): 5469.


Betaine and Omeprazole tapering

slippery elm bark tea

56) How to Wean Off Acid Blockers  I like slippery elm bark tea as it’s very easy to take and very soothing to the stomach. Slippery elm bark is mucilaginous and helps to coat and soothe the stomach lining. It can also help with acid reflux as well. (source).

To make a tea, get some slippery elm bark in powder form and take 1-2 teaspoons, mix with a little cold water into a smooth paste, then pour boiling water over it and continue to whisk and stir for a few minutes until it forms a slippery consistency. You can add a squeeze of lemon or even better, some fresh chopped ginger (which also has gut healing properties) to improve the taste a little. Drink a few cups throughout the day as well as well as in the evening before bed.



57) Tapering off Proton Pump Inhibitors
by Dr. Dawn Motyka

We assume you are a chronic user of Prilosec / Prevacid / Aciphex etc. If you have active erosions in the esophagus or stomach ulcers, you should not stop your PPI until these are healed. This advice is intended for GERD sufferers who have severe flares when they try to stop PPIs but are without symptoms if they take them.
First obtain the following:
1. Betaine HCl from a health food store – 500MG
2. Reglan: 5mg #100 -Rx. Optional. Can try without this first and see if needed. Generic name is metaclopromide. Not everyone can use this as it has drug interactions.
3. Zantac: 75mg #60 – OTC
4. DGL – deglyccerized licorice 200mg. Regular licorice is not correct and may raise blood pressure at this dose.
Follow these instructions to the letter:
Avoid These:
A- Acids- Vinegar/Citrus Fruits
A- Aspirin (Alka-Seltzer, Motrin, Advil, nuprin, etc.)
A- Alcohol
S- Spices- Chili
C- Caffeine- coffee, tea, colas, chocolates
N – Nicotine (Smoking)
S- Skipped meals
Tight Belts, waistbands, lying down and running right after meals.
Do These:
-Nothing to eat within two hours of bedtime
-Raise head of bed 6″ (bricks or 2 X 4 boards)
-Maalox/Mylanta- two tablespoons after meals
-Don’t mix solids with liquids
The night of the last PPI dose, Take (2) Zantac 75mg pills at bedtime. You will continue this for at least 2 weeks and possibly long term (safer than PPI). Also begin the DGL at a dose of around 200mg. Pure Encapsulations makes a product called Heartburn Essentials that contains this. I like this product a lot.
At the start of each meal, take 2 Betaine HCL, 200mg of DGL and the Reglan. This can be repeated up to six times a day if you are following the advice to eat small frequent meals.
Sometimes it is necessary to taper the PPI dose gradually. Continue the program for at least 2 weeks. When you are symptom free for 2 weeks, stop the Reglan and the DGL. Wait a week and if all is well, try going without the Zantac. Continue the Betaine. If all is well for another week then try going without the Betaine and watch for belching and heartburn to recur

PDF  PPI WEANING PROTOCOL © Nutritional Therapy Association, Inc.® 1 Acid Blocker Weaning Protocol RECOMMENDATIONS FOR WEANING OFF OVER-THECOUNTER

Begin by taking your regular dose of OTC PPI medication every other day for 1-2 weeks as your symptom level allows. If symptoms exacerbate beyond a tolerable level, try taking a half dose daily for a few days, then wean back to a reduced dose every other day. Follow dietary guidelines as given, particularly avoiding refined carbohydrates and sugar, alcohol, caffeine, excessive amounts of raw veggies, capsaicin and other hot pepper byproducts, and tannins in black teas.

• While weaning, use stomach healing nutrients daily as recommended by your Nutritional Therapy Practitioner or Nutritional Therapy Consultant, for example: Vitamin A, cabbage juice or Vitamin U, Vitamin D, 100% aloe vera juice, bone broth, chlorophyll, deglycyrrhizinated licorice (DGL), LGlutamine, Jerusalem artichoke, milk thistle, probiotics, slippery elm, or marshmallow root. In addition, 1-2 tablespoons of raw apple cider vinegar in 4 ounces of room temperature water at the beginning of each meal is recommended to promote gastric enzyme activity. • On the “off” days from taking OTC PPI medication, take a hydrochloric acid (HCl)/enzyme supplement (1-3 tablets) with each meal, as well as the stomach-healing nutrients. If intolerable acid reflux occurs, eat a few more bites of a protein food, or drink a small amount of baking soda in water (one teaspoon of baking soda dissolved in 4 ounces room temperature water), or plain seltzer water, to calm your stomach.

58)  The Challenges and Pitfalls of PPI Withdrawal  By Vincent Pedre, MD

59) Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria

60)  Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence?

61) Björnsson, E., et al. “Discontinuation of proton pump inhibitors in patients on long‐term therapy: a double‐blind, placebo‐controlled trial.” Alimentary pharmacology & therapeutics 24.6 (2006): 945-954.

Of the 97 patients enrolled, had used PPIs for 48 months, 78% had GERD. A total of 27% did not use PPIs during the year after discontinuation, 31% of the patients randomized to tapering discontinued PPIs and 22% of those who did not could discontinue therapy (NS). Gastro-oesophageal reflux disease (GERD) patients were more prone to continue PPIs than non-GERD patients. Only 16 (21%) of GERD patients were off PPIs vs. 48% of patients without GERD (p < 0.05). Serum gastrin was higher at baseline in GERD patients who resumed PPIs versus non-resumers (p < 0.05). GERD and serum gastrin were independent predictors of PPI requirement.

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Jeffrey Dach MD

The post Getting Off Omeprazole-Prilosec and other PPIs appeared first on Jeffrey Dach MD.

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